MAUDE MDR 4186143

MDR report key
4186143
Report number
1823260-2014-08067
Event key
0
Event type
3
Date of event
2014-09-16
Date received
2014-10-20
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
NA MICHAEL LESLIE
Address
9115 HAGUE ROAD NA INDIANAPOLIS IN 46250 US
Phone
317-317-3175
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1C-REACTIVE PROTEIN GEN.3SYSTEM, TEST, C-REACTIVE PROTEINROCHE DIAGNOSTICSDCNNA0495684219068661201R Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-10-200

Event Narratives#

D

Patient 1

THE CUSTOMER REPORTED THAT THEY RECEIVED QUESTIONABLE RESULTS FOR EIGHT DIFFERENT SAMPLES FROM THE SAME PATIENT TESTED FOR C-REACTIVE PROTEIN GEN.3 (CRP). THE PATIENT'S PHYSICIAN WAS CONCERNED BECAUSE THE CRP RESULTS WERE CONSIDERED TO BE NEGATIVE, BUT BLOOD CULTURES FOR THIS PATIENT WERE POSITIVE. THE CRP VALUES FROM ALL EIGHT SAMPLES WERE QUESTIONED BY THE PHYSICIAN. SAMPLES WERE TESTED ON 2 DIFFERENT C501 MODULES. THIS MEDWATCH IS FOR REAGENT LOT 68661201 WITH AN EXPIRATION DATE OF (B)(6) 2014 AND USED ON C501 SERIAL NUMBER (B)(4). THE FIRST SAMPLE RESULTED AS 2.0 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE SECOND SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 1.9 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE THIRD SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 2.8 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE FOURTH SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 0.1 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE FIFTH SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 0.2 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE SIXTH SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 1.2 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE SEVENTH SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 0.9 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE EIGHTH SAMPLE, TESTED ON (B)(6) 2014, RESULTED AS 1.1 MG/L ON C501 MODULE SERIAL NUMBER (B)(4). THE PATIENT HAD TWO BLOOD CULTURE SAMPLES THAT WERE DRAWN AT THE SAME TIME ON (B)(6) 2014. ONE BLOOD CULTURE SAMPLE WAS A LINE DRAW AND THE OTHER SAMPLE WAS A PHLEBOTOMY DRAW. THE FINAL RESULTS FOR BOTH CULTURES YIELDED STAPHYLOCOCCUS EPIDERMIDIS. THE PHYSICIAN TREATED THE PATIENT WITH VANCOMYCIN SINCE HE DID NOT BELIEVE THE CRP RESULTS. THE PATIENT IS STILL IN THE HOSPITAL SINCE IT WAS A PREMATURE NEWBORN. THERE WAS A SUBSEQUENT NEGATIVE BLOOD CULTURE RESULT ON (B)(6) 2014, BUT THE PATIENT IS STILL ON VANCOMYCIN. THE PATIENT WAS NOT ADVERSELY AFFECTED. THE CUSTOMER DECLINED A SERVICE VISIT.

N

Patient 1

IT WAS UNKNOWN IF THE INITIAL REPORTER SENT REPORT TO THE FDA. REFERENCE THE MEDWATCH WITH PATIENT IDENTIFIER (B)(4) FOR ADDITIONAL DATA RELATED TO THIS EVENT.

N

Patient 1

A SPECIFIC ROOT CAUSE COULD NOT BE DETERMINED BASED ON INFORMATION PROVIDED. ADDITIONAL INFORMATION FOR FURTHER INVESTIGATION WAS REQUESTED BUT NOT PROVIDED. THE CUSTOMER STATED THAT SAMPLES WERE RUN IN MICRO CUPS, BUT DOES NOT KNOW IF THE SAMPLES HAD BEEN PROGRAMMED SPECIFICALLY AS MICRO CUP SAMPLES. IF THE SAMPLES WERE NOT PROGRAMMED AS MICRO CUP SAMPLES, THIS COULD HAVE BEEN THE CAUSE OF THE ISSUE AS SAMPLE PIPETTING MAY BE INACCURATE IF NOT SELECTED, WHICH COULD LEAD TO INACCURATE MEASUREMENTS.